Regional tumor board improved time to treatment for patients with HCC

SAN FRANCISCO — In patients geographically removed from tertiary care centers, the creation of a regional multidisciplinary tumor board decreased the time from first abnormality to treatment by 25 days, cutting time from abnormality to specialist consult in half, according to a poster presentation at The Liver Meeting 2015.

“The creation of a [liver cancer tumor board] improved access to HCC care, reduced unnecessary biopsies, shortened time from identification to treatment primarily due to improvement from spokes sites,” Eric M. Egert, PA-C, from the Coatesville, Pennsylvania, Veterans Affairs Medical Center, and colleagues wrote in the abstract.

Egert and colleagues across eastern Pennsylvania and Delaware formed a regional liver cancer team comprised of four “spokes centers” and one tertiary hub, using telehealth to encourage face-to-face interaction between referring providers and the central liver tumor board, according to the abstract. Meetings began weekly in July 2014 and telehealth played a role in patient interaction with the specialist when necessary.

Looking to assess the impact of the new program, researchers gathered dates for first radiologic or serologic abnormality, first CT or MRI, first consultation order to the tertiary hub, first cancer plan and first intervention for those diagnosed with HCC. Data was collected for the year prior to implementation and 10 months after the liver tumor board first met.

Researchers found 61 patients diagnosed before the board (n = 37 in spoke centers; n = 28 in the hub) and 63 diagnosed after the board was in place (n = 26 spokes; n = 37 hub).

After implementation of the tumor liver board, the number of cases diagnosed by biopsy vs. imaging declined from 15 of 61 (24%) to four of 63 (6%, P = .006). The time from first abnormality to evaluation by a specialist or the board declined from 44 days to 21 days (P = .0018), mainly for those cases at spoke centers (55 days to 23 days, P = .0004).

Similarly, at the spoke centers, time from first abnormality to first treatment declined from 79 days to 54 days (P = .025). The number of resections performed increased from none prior to the board to six after board implementation (P = .015).

“These data mimic HCC care access improvements achieved with a similar program … suggesting that this model warrants exploration for further implementation within the VA system and possibly in private settings,” the researchers wrote. – by Katrina Altersitz

Reference:

Egert EM, et al. Abstract 521. Presented at: The Liver Meeting; Nov. 13-17, 2015; San Francisco.

Disclosures: Egert reports no relevant financial disclosures. Please see the abstract for list of all other authors’ relevant financial disclosures.